ACQ Vol 10 No 3 2008

INTERVENTION: WHY DOES IT WORK AND HOW DO WE KNOW?

E thical C onversations

Marie Atherton

just because an opinion is posted on the web doesn’t mean it’s of high quality or comes from an authoritative source. So it’s important to try and weigh up those issues as you trawl through the literature and web-based material. Sometimes it’s possible to find “responses” to new therapies and approaches by speech pathologists and/or researchers with some authority. This can give you a sense of how the new therapy is being received and viewed by the profession more generally. However, some of what is on the web will be media pieces extolling the new therapy, and so must be treated with caution. Having learnt as much as we can locally we might seek further counsel and contact researchers or academics at the local children’s hospital or university speech pathology department. They are always most generous with their knowledge and welcome contact with therapists in the community over questions like this one. Finally though, it’s time to report back to Geraldine. Occasionally, this can be straightforward when your research has yielded conclusive results either for or against the therapy approach in question. However, more often the picture is inconclusive. For example, there may be conflicting views about the new approach. Alternatively, there may be some encouraging early results for some children but it may not be possible currently to say whether the treatment will be of significant value for Julie. Nonetheless, it is important to present what you have learned, the view that you have formed and why. Of course, it is ultimately Geraldine’s decision whether to proceed, and it may be difficult for the therapist if a parent decides to proceed despite the research results presented to them. However, there is very little that can be done about this and in the end what matters is that you have presented the information in an accurate and unbiased manner and have conducted yourself ethically. Failure to do reflects poorly on our profession. Response from Kate Short, acting head of Liverpool Hospital Speech Pathology Department, New South Wales This is not an uncommon scenario for those of us working in a large public hospital and one which we sometimes discuss over lunch and in supervision. We encourage discussion of these issues and often include them in our monthly case presentations. There are a number of ethical dilemmas that require consideration here. Conflict of interest If working as a private practitioner, I would benefit financially from Julie continuing to attend weekly sessions with me. However, if Geraldine, chooses for Julie to begin the “new” treatment, it may mean that Julie must attend a different clinic, thereby terminating sessions with me and impacting me financially. As such, I may benefit from Geraldine choosing not to undertake the “new” treatment. Conversely, I may be able to provide this “new” treatment to Julie. It may require the delivery of more intensive services by me; thus I may gain by Geraldine’s decision for her daughter to undertake the “new” treatment.

T here is rarely one opinion or right answer when it comes to ethical dilemmas in clinical practice. These dilemmas deal with real people in real life situations which can be complicated and messy. In order to practice speech pathology ethically we must be able to think through and clearly communicate the ethical issues that arise in our daily practice. The following case scenario deals with one of the nine key trends and issues in ethical practice in speech pathology (Atherton, 2007), that is the increased emphasis on evidence -based practice. There will be many different responses to it. It is hoped it also stimulates many conversations. Case scenario You are a speech pathologist working in private practice. Julie is a 7-year-old with severe receptive and expressive language impairment and literacy difficulties. You have provided weekly sessions for Julie for several months. Her mother, Geraldine, has done lots of reading about language impair­ ment and is very involved in Julie’s therapy. Geraldine arrives at this week’s session to tell you she has found information about a “new” therapy on the web. It is a computer-based intervention and requires the outlay of several thousand dollars. The information suggests Julie could make significant improvements in minimal periods of time. Geraldine asks for your opinion about whether she should stretch the family budget and enrol Julie in the treatment. This is certainly a familiar scenario for therapists in our practice – questions from parents have arisen in response to a number of “new” therapies. As parents ourselves we certainly appreciate the attraction of the claimed new therapy outcomes and Geraldine’s powerful urge to do everything she possibly can to support and assist her child. However, we have a clear responsibility to Geraldine to help her assess the value of alternate therapies and approaches. The key to giving an ethical answer is to check the research and present the scientific evidence to date. In seeking to adequately advise Geraldine, most of us would start with the most obvious sources of information and check with trusted work colleagues and associates. The Internet also has become an invaluable resource, at least as a more general orientation to a topic or approach. Of course, The purpose of this “Ethical Conversations” column is to promote reflection and discussion on what demonstrates ethical practice in speech pathology, and to encourage us to think about using a framework that considers ethical practice in a proactive way. We may think about the Association’s Code of Ethics (2000) as something to turn to when faced with a dilemma, but it can also be a useful guide in our everyday practice, “in thinking and acting ethically within the routine, ordinariness of professional life” (McAllister, 2006). Response from Karen Walter and Mandy Brent, speech pathologists, Extra Ed, Victoria

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